Background: No recent meta-analysis has holistically analyzed and summarized the efficacy and safety of omarigliptin in type 2 diabetes mellitus (T2DM). We conducted a meta-analysis to address this knowledge gap. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) that included patients with T2DM who received omarigliptin in the intervention arm. The control arm consisted of either a placebo (passive control group [PCG]) or an active comparator (active control group [ACG]). The primary outcome assessed was changes in hemoglobin A1c (HbA1c), while secondary outcomes included variations in glucose levels, achievement of glycemic targets, adverse events (AEs), and hypoglycemic events. Results: From 332 initially screened articles, data from 16 RCTs involving 8,804 subjects were analyzed. Omarigliptin demonstrated superiority over placebo in reducing HbA1c levels (mean difference, –0.58%; 95% confidence interval, –0.75 to –0.40; P<0.00001; I2=91%). Additionally, omarigliptin outperformed placebo in lowering fasting plasma glucose, 2-hour postprandial glucose, and in the percentage of participants achieving HbA1c levels below 7.0% and 6.5%. The glycemic efficacy of omarigliptin was similar to that of the ACG across all measures. Although the omarigliptin group experienced a higher incidence of hypoglycemic events compared to the PCG, the overall AEs, serious AEs, hypoglycemia, and severe hypoglycemia were comparable between the omarigliptin and control groups (PCG and ACG). Conclusion Omarigliptin has a favorable glycemic efficacy and safety profile for managing T2DM.

Introduction: The use of e-cigarettes has increased rapidly around the world including in Malaysia. However, a significant proportion of people who started using e-cigarettes later discontinued using them. The aim of this study is to identify prevalence of former e-cigarette use and factors associated with quitting, among Malaysian adults. Methods: This study is a part of a national household survey examining the use of e-cigarettes among Malaysian adults aged 18 years and above in 2016. A multistage stratified cluster sampling method was used in the survey. A bilingual (Malay and English) structured questionnaire was used and data was collected via face-to-face interview. Prevalence of current e-cigarette use and former e-cigarette use were determined. A multiple logistic regression model was used to identify factors associated with quitting e-cigarettes. Results: A total of 4,288 adults participated in the survey, where 110 (3.2%) and 289 (8.6%) were identified as current and former e-cigarette users respectively. The following factors were significantly associated with quitting e-cigarette use: e-cigarette users who had no exposure to e-cigarettes at the workplace (aOR = 2.70; 95% CI: 1.39, 5.24); the perception that e-cigarette is more harmful to others compared to tobacco smoke (aOR = 2.46; 95% CI: 1.22, 4.97); and the perception that e-cigarettes do not help people to maintain cigarette abstinence (aOR = 2.19; 95% CI: 1.23, 3.92). Conclusions This study contributes to a better understanding of the factors associated with cessation of e-cigarettes. Findings from this study can assist any e-cigarette cessation intervention measures.

Introduction: Data on water and sugar sweetened beverages (SSB) intake among young adults in Malaysia is sparse. This study aimed at measuring the intake of plain water and SSB among undergraduate students in a Malaysian university and examine its association with body mass index (BMI). Methods: A total of 376 undergraduate students aged 18-30 years were recruited. A selfadministered questionnaire was used to determine the SSB consumption pattern. The questionnaire consisted of five sections that included the background of the participants, knowledge about SSB, SSB preferences, frequency and portion size. Results: 23.9% of subjects in this study were overweight. Almost all of the subjects took outside food (93.1%) and drink (74.2%). The highest daily consumption was plain water (92.3%), with a majority drinking more than two cups at each intake. Caffeinated drinks (coffee or tea) were the most popular SSB among the students (18.4%). Most students (79.7%) did not consume SSB on a daily basis. A significant association was found between the proportion of plain water consumption and BMI (p<0.05). Those who were overweight consumed a greater amount of plain water as compared to those underweight. Conclusion: Our findings of low plain water intake among the underweight may be used to tailor intervention efforts to increase its intake and reduce that of SSB, especially among underweight young adults.

Introduction: Peripheral nerve injuries (PNI) are a disabling injury as it often results in motor and sensory deficit with cognitive impairment. Flaxseed oil provides a good source of omega-3 fatty acid and it is believed to be able to protect the damaged nerve cell for successful nerve recovery. This study aimed to investigate a potential neuro-regeneration properties of flaxseed oil in treating the PNI. Methods: A total of 65 rats were separated into 4 groups: Group 1: Normal group (n=5), Group 2: Negative group (n=20), Group 3: Experimental group (n=20) and Group 4: Positive control (n=20), all the group were further divided into 4 groups (post-operative 7, 14, 21, 28 days, n=5 for each days). The functional restoration was assessed by walking track analysis (Sciatic Functional Index analysis-SFI) and toe spreading reflex (grading score). Electron microscope studies were performed on sciatic nerve to evaluate the regenerative process through morphologic and morphometric changes. Results: Oral administration of flaxseed oil (experimental group) at 1000 mg/kg body weight/day showed better recovery compared to negative control value. However, there was no significant difference in SFI and toe spreading reflex between positive (mecobalamin) and experimental group (flaxseed oil). Morphological and morphometrical findings indicated increases in the myelin thickness and myelin sheath layer after administration of flaxseed oil. Conclusion: The flaxseed oil supplementation could enhance the neurorestorative capacities of injured sciatic nerve.

Introduction: To ensure that they will be the safe health-care providers, the medical schools must guarantee that their students meet the predetermined criteria before graduating. To fulfil this condition, usually a small proportion of students, need remedial training before they could graduate. In October 2018 we designed an academic remediation programme for 24 students who were to re-appear in their Final Professional MBBS Examination (FPE) in March/ April 2019. Aim of the remediation programme was not only to help the students to pass the examination but also to train them as safe future doctors. Methods: A rotational programme was drawn to cover all the relevant disciplines. A number of well-planned interventions were applied. A clinical examination in various combinations of a long case, short cases and OSCE stations was conducted at the end of each rotation and the written examination was conducted after completing the full 24 weeks of the programme before they sat in the FPE. Results: The five most useful interventions identified in the students’ feedback included: “Patient to book approach”; Mentoring; Group study; Mock examinations and Flipped class-rooms. Eighteen of the 24 (75%) students passed the FPE. The five of the six students failed because of the poor performance in the clinical examination. Conclusion: Remedial interventions can be successful by having clear goals and directions. Individualized approach in identifying and addressing the issues and by seeking help from the relevant professionals ensures the success.

Background: Pre-existing comorbidities can predict severe disease requiring intensive care unit (ICU) admission among COVID-19 cases. We compared comorbidities, clinical features and other predictive factors between COVID-19 patients requiring ICU admission for intubation/mechanical ventilation and all other COVID-19 cases in Selangor, Malaysia. Methods: Field data collected during the COVID-19 outbreak in Selangor, Malaysia, up to 13 April 2020 were used, comprising socio-demographic characteristics, comorbidities and presenting symptoms of COVID-19 cases. ICU admission was determined from medical records. Multiple logistic regression analysis was performed to identify factors associated with ICU admission requiring intubation/mechanical ventilation among COVID-19 cases. Results: A total of 1287 COVID-19-positive cases were included for analysis. The most common comorbidities were hypertension (15.5%) and diabetes (11.0%). More than one third of cases presented with fever (43.8%) or cough (37.1%). Of the 25 cases that required intubation/mechanical ventilation, 68.0% had hypertension, 88.0% had fever, 40.0% had dyspnoea and 44.0% were lethargic. Multivariate regression showed that cases that required intubation/mechanical ventilation had significantly higher odds of being older (aged 360 years) [adjusted odds ratio (aOR) = 3.9] and having hypertension (aOR = 5.7), fever (aOR = 9.8), dyspnoea (aOR = 9.6) or lethargy (aOR = 7.9) than cases that did not require intubation/mechanical ventilation. Conclusion: The COVID-19 cases in Selangor, Malaysia requiring intubation/mechanical ventilation were significantly older, with a higher proportion of hypertension and symptoms of fever, dyspnoea and lethargy. These risk factors have been reported previously for severe COVID-19 cases, and highlight the role that ageing and underlying comorbidities play in severe outcomes to respiratory disease.

Introduction: Posttraumatic stress disorder (PTSD) is a mental health condition which develops following exposure to life-threatening events. This cross-sectional study was conducted among adult patients from all walks of life who had injuries related to motor vehicle accidents to determine the cut-off point of the Malay Posttraumatic Stress Disorder Checklist For DSM-5 (MPCLC-5) for its use as a screening tool for PTSD in the Malaysian population. Methods: Using convenient sampling method, 204 subjects who fulfilled the inclusion criteria were recruited and they were given the 17 item self-rated MPCLC-5 to fill up. Subsequently, trained personnel administered the gold standard Clinician Administered PTSD Scale for DSM 5 (CAPS-5). ROC curve analysis was done to determine appropriate cut-off point for the MPCLC-5. Results: Cut off point of 42/43 would yield the most preferable sensitivity and specificity for MPCLC-5 when compared to CAPS-5 (Sensitivity: 67.56% (95%CI 55.68% to 78.00%); Specificity : 80% (95% CI 72.08% to 86.50%) ). Conclusion: The easy to administer MPCLC-5 is suitable for screening of PTSD among local patients with a proposed cut off point of 42/43.

Introduction: Cardiovascular disease (CVD) is a group of disease which are related to the heart and its circulations. The main modifiable risk factors of the CVD disease are hypertension, hyperglycemia and obesity. This study aims to evaluate the knowledge, awareness and practice on cardiovascular disease risk factors among Gombak community in Kuala Lumpur. Methods: This was a cross-sectional study using self-administered questionnaire and anthropometric measurement among 388 subjects in Gombak District, Kuala Lumpur. Descriptive data analysis and multivariate binary logistic regression were carried to identify demographic and factors associated. Results: The prevalence of the risk factors was high among study subjects, including obesity (24.2%), hypertension (42.3%) and hyperglycemia (26.8%). More than half (64.4%) of the study subjects having at least one of the risk factor. The multivariate binary logistic model factor illustrated that compare to Malays, Chinese were 37% less likely to have obesity (CPR=0.67; 95% Cl: 0.26-1.69). Gombak district community are more likely to have the knowledge on the CVD risk factor but lack of awareness and poor in practicing the prevention action. The Indian ethnic group was less likely to be aware (APR: 0.33, Cl: 0.05-2.31) and others bumiputera ethnic group were less likely to prevent (APR: 0.58, CI: 0.20-1.65) the risk of CVD. The Chinese ethnic less likely to have the knowledge (APR: 0.88, Cl: 0.35-2.22). Conclusion: Gombak community was more likely to have the knowledge but less likely to be aware and lack of practice of prevention of the risk factors of CVD.

The spraying of insecticide on foliage to provide an insecticidal barrier may serve as part of the vector control measures to combat the increasing threat of Aedes-borne diseases. The effectiveness of insecticide barrier spraying was evaluated by assessing the residual efficacy of deltamethrin sprayed on foliage against Malaysian Ae. aegypti (L.) and Ae. albopictus (Skuse). In this semi-field study, landscape plants grown within the vicinity of the Institute for Medical Research (IMR), Malaysia, were treated with deltamethrin suspension concentrate (SC) with the dosage of 30 mg/m2 and 50 mg/m2 in three rounds of spraying. Deltamethrin residual activity on treated and untreated leaves was investigated using standard WHO cone bioassays. Wild Aedes populations at both deltamethrin-treated and untreated plant clusters were monitored by ovitrap surveillance. Ovitrap monitoring revealed that the mean number of Ae. albopictus larvae at deltamethrin-treated were significantly lower than the mean number of larvae of the same species at the untreated plant cluster. Cone bioassay results showed that the insecticide remained effective for up to 4 weeks (> 80% mortality), but the insecticide residual activity was affected by rainfall. These results suggest that insecticide barrier spraying is a promising tool and may be used along with other mosquito control tools such as indoor residual spray and space spraying to reduce the dengue burden.

Introduction: Community health workers/volunteers (CHW) are health workers who are trained but do not possess a formal professional certificate. They are members of the community who live and work in that particular community. This study aimed to determine factors associated with not performing health screening activities by volunteers under KOSPEN; a community-based intervention programme, initiated by Ministry of Health Malaysia in October 2013. Methods: Data from the “Evaluation of the implementation of KOSPEN programme in Malaysia 2016” was used,a cross-sectional study which was carried out in randomly selected KOSPEN localities throughout Malaysia. The response rate was 94.9%. A pre-tested, self-administered questionnaire was used. Descriptive statistics andlogistic regression analysis was applied using Statistical Package for Social Sciences (SPSS) version 20. Results: 700 volunteers were included in this study. Majority were female (65.7%), aged 50-59 years (30.9%), had secondary education (65.3%), employed (55.7%.) and married (80.4%). Several issues were identified by the volunteers; funding (47.2%), module content and comprehensibility (11.4% respectively), submitting returns (17%). Multivariate logistic regression showed that volunteers who never attended training (aOR 2.79; 95% CI:1.66, 4.67) and who felt the content of the training module was inadequate (aOR 2.693; 95% CI: 1.46, 4.98) were more likely did not perform screening activities in the community. Conclusion Volunteers who were not trained and those who felt the content of the training module was inadequate did not carry out screening activities. These findings will be useful for stakeholders to make improvements to the programme for a more successful implementation.